FROM THE ACADEMY
Nutrition Care Process (NCP) Update Part 2:
Developing and Using the NCP Terminology to
Demonstrate Efficacy of Nutrition Care and
Related Outcomes
William I. Swan, FAND; Donna G. Pertel, MEd, RD, LDN; Brenda Hotson, MSc, RD*; Lyn Lloyd, RD‡; Ylva Orrevall, PhD, RD§;
Naomi Trostler, PhD, RD, FADN; Angela Vivanti, DHSc, AdvAPD¶; Kay Beck Howarter, MS, RDN; Constantina Papoutsakis, PhD, RD
N
UTRITION AND DIETETICS
practitioners around the
world use the Nutrition Care
Process Terminology (NCPT)
to communicate the Nutrition
Care Process (NCP).1 In this article,
nutrition and dietetics practitioners or
professionals; dietitians; dietitians-
nutritionists; and dietetic technicians,
registered, are collectively referred to
as professionals. The NCPT is a stan-
dardized terminology or controlled vo-
cabulary that complements the NCP, a
systematic problem-solving roadmap
for planning and providing nutrition
and dietetic care to individuals and
populations, and researching related
outcomes. Recently, a scheduled up-
date of the NCP and Model (NCPM)
was published.2 The NCPM is the
graphic representation of the NCP. The
NCP includes four steps that collec-
tively describe the unique contribu-
tions of nutrition and dietetics
practitioners. These steps are Nutrition
Assessment and Reassessment, Nutri-
tion Diagnosis, Nutrition Intervention,
and Nutrition Monitoring and Evalua-
tion. A companion to the model update
publication, this article reviews the
background of the NCP and describes
the current state and ongoing enhance-
ments of the NCPT.2 A further aim is to
*Certified in Canada.
‡
Certified in New Zealand.
§ these existing vocabularies adequately
Certified in Sweden.
¶ communicated the scope of nutrition
Certified in Australia.
2212-2672/Copyright ª 2019 by the
Academy of Nutrition and Dietetics.
https://doi.org/10.1016/j.jand.2018.10.025
ª 2019 by the Academy of Nutrition and Dietetics.
illustrate how the NCPT communicates
the unique functions of nutrition and
dietetics practitioners and supports
the research on nutrition and dietetics
care. This article replaces previous in-
formation on the use of the NCPT.
A DECADE OF USE AND
DEVELOPMENT
The NCPT, formerly known as the Inter-
national Dietetics and Nutrition Termi-
nology (IDNT), was designed to meet the
definition of a controlled vocabulary as
determined by the National Library of
Medicine.3 This means that the NCPT is a
system of terms organized in a hierar-
chical structure, with definitions and
cross-references used to index and
retrieve a body of literature in a biblio-
graphic, factual, or other database.4 The
NCPT was initially presented as a docu-
mentation tool for electronic health re-
cords (EHRs).5 Of note, the IDNT became
the NCPT in 2014 to emphasize its link-
age to the NCP. Today, the NCPT is a tool
that standardizes nutrition and dietetics-
related communication beyond the
health care setting and is capable of
demonstrating quality of care and related
outcomes.
In 2003, the Academy of Nutrition
and Dietetics (Academy), formerly the
American Dietetic Association,
completed a review of defined health
care vocabularies to evaluate whether
care. Although several of the defined
terms at the time included nutrition-
focused terms, they did not describe
the complete range or the specific ac-
tivities performed by nutrition and di-
etetics practitioners.6
JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS
To address this gap in nutrition and
dietetics terminology, the Standardized
Language Task Force, composed of 12
Academy member volunteers supported
by terminology consultants and Academy
staff, undertook development of termi-
nology for the NCP step Nutrition Diag-
nosis. Sixty-two Nutrition Diagnosis
terms were published in 2006.7 Subse-
quently, the Task Force developed terms
for the Nutrition Assessment, Nutrition
Intervention, and Nutrition Monitoring
and Evaluation NCP steps. As a result, an
official terminology that supported all
four steps of the NCP was published in
2008.8 Currently, the NCP Outcomes
Research Committee (NCPROC) of the
Academy oversees the development and
maintenance of the NCPT with support
from its workgroups (ie, International,
Advisory, and Classification) and in
collaboration with the Council on
Research, Informatics, and Interopera-
bility and Standards Committees. The
complete NCPT (electronic NCPT [eNCPT])
is released once a year and is available
through a web-based platform.1 A book,
the Abridged Nutrition Care Process Termi-
nology (NCPT) Reference Manual: Stan-
dardized Terminology for the Nutrition Care
Process9 provides a select subset of NCP
terms in print form.
The NCPT has developed in several
aspects since its original launch. Several
international nutrition and dietetics or-
ganizations work collaboratively with
the Academy to support, adopt, and
translate the NCPT into different lan-
guages (Figure 1).10-12 Also, the appli-
cation and related experiences with
NCPT have been reported in various
practice and education settings.13-19 To
better communicate nutrition care in
practice and research, processes for
1
FROM THE ACADEMY
Figure 1. International translations timeline. Countries that translated during the same year are listed in alphabetical order. *Country that
has conducted regular updates of the Nutrition Care Process Terminology. ND¼nutrition diagnosis. NI¼nutrition intervention.
modifying the NCPT have been imple-
mented by the NCPROC that ensure a
responsive environment for NCPT
enhancement. As a result, the number
of NCPT terms has expanded to support
the range of skills and roles of nutrition
and dietetics practitioners. Synonyms
have been added that embrace practice
and cultural sensitivities. Because the
NCPT is among many health care ter-
minologies, its terms are submitted to
larger interdisciplinary international
clinical terminology standards such as
Systematized Nomenclature of
Medicine-Clinical Terms (SNOMED-CT)
and Logical Observation Identifiers
Names and Codes (LOINC) on an
ongoing basis.20,21 In recent years, the
NCPT has been used in practice-focused
nutrition research showing the efficacy
and degree of application of the NCP, as
well as adherence to evidence-based
nutrition practice guidelines.18,22-24
NCPT: THE STANDARDIZED
TERMINOLOGY OF NUTRITION
AND DIETETICS
The NCPT is organized by NCP steps
and within each step it is organized by
2 JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS
domains, classes, and subclasses
(Figure 2). An extensive number of NCP
terms have reference sheets that serve
as a descriptive profile for the term.
NCP terms on the reference sheets are
defined in the case that they do not
exist in the international clinical ter-
minology standards described else-
where in this article.
The purpose of the NCPT is to provide
an accurate and specific description of
the services that nutrition and dietetics
practitioners deliver, and the investiga-
tion of resulting outcomes. This achieves
a common understanding not only
among nutrition and dietetics practi-
tioners, but also outside the profession,
including clients (individuals or pop-
ulations) and other disciplines. Another
substantial purpose of the NCPT is that it
provides a means to show the influence
of nutrition care on outcomes and quality
of care to health professionals and the
public. Regardless of chosen note format
(eg, the traditional Subjective, Objective,
Assessment, Plan system or the Assess-
ment, Diagnosis, Intervention, Moni-
toring, Evaluation system) or other
means of documentation/reporting
based on policy or personal preference,
nutrition and dietetics practitioners use
NCPT to communicate care with preci-
sion.23,25 Examples of the application of
NCP using NCPT in a variety of practice
settings are illustrated in Figure 3.
In a dynamically evolving health care
environment, the vision for the NCP and
NCPT is to facilitate communication
within and among health care systems
for outcomes research and quality
improvement. Thus, the NCPT is an
important tool to advance the field of
nutrition and dietetics, related educa-
tion, research, and policy as the updated
logic model guiding terminology
development demonstrates (Figure 4).
Acceptance and Adoption
The NCPT supports application of the
NCP in numerous countries. The Euro-
pean Federation of the Associations of
Dietitians Report on Knowledge and Use
of a Nutrition Care Process and Stan-
dardized Language by Dietitians in
Europe11 reported that there were
positive attitudes for the use of a
standardized terminology that de-
scribes the NCP. At the time of this
survey, seven European countries
-- 2019 Volume - Number -
 FROM THE ACADEMY

NCP STEP DOMAIN HIGHLIGHT ON NEW TERMS

Food and Nutrition-Related
History (381 terms)
Assessment and
Reassessment
Anthropometric
Measurements (88 terms)
(1,083 terms)

Biochemical Data, Medical

Tests, and Procedures
(228 terms)

Nutrition Focused Physical

Findings (348 terms)

Client History (38 terms)

Detail Showing Malnutrition (undernutrition) Terms

Malnutrition (undernutrition) (NC-4.1)
Starvation related malnutrition NC-4.1.1
Moderate starvation related malnutrition NC-4.1.1.1
Diagnosis (166 terms)

Severe starvation related malnutrition NC-4.1.1.2

Intake (111 terms)
Chronic disease or condition related malnutrition NC-4.1.2
Moderate chronic disease or condition related malnutrition
NC-4.1.2.1
Clinical (38 terms) Severe chronic disease or condition related malnutrition
NC-4.1.2.2

Acute disease or injury related malnutrition NC-4.1.3

Behavioral/ Environmental Moderate acute disease or injury related malnutrition
(17 terms) NC-4.1.2.1
Severe acute disease or injury related malnutrition
NC-4.1.2.2

Non illness related pediatric malnutrition NC-4.1.4

Mild non illness related pediatric malnutrition NC-4.1.4.1
Moderate non illness related pediatric malnutrition NC-4.1.4.2
Food and/or Nutrient Severe non illness related pediatric malnutrition NC-4.1.4.3
Intervention (400 terms)

Delivery (302 terms)

Illness related pediatric malnutrition NC-4.1.5

Nutrition Education Mild illness related pediatric malnutrition NC-4.1.5.1
(6 terms) Moderate illness related pediatric malnutrition NC-4.1.5.2
Severe illness related pediatric malnutrition NC-4.41.5.3
Nutrition Counseling
(16 terms)

Coordination of Nutrition
Care by a Nutrition Detail Showing Populaon Based Nutrion Acon Classes
Professional (9 terms)
Populaon Theorecal Frameworks (P-1)
Population Based Nutrition
Action (67 terms) Populaon Strategies (P-2)

Populaon Sengs (P-3)

Populaon Sectors (P-4)

Food and Nutrition-Related
Evaluation (1,045 terms)

History (381)
Monitoring and

Anthropometric
Measurements (88 terms)

Biochemical Data, Medical

Tests, and Procedures
(228 terms)

Nutrition Focused Physical

Findings (348 terms)

Figure 2. Nutrition Care Process (NCP) Terminology hierarchy.

-- 2019 Volume - Number - JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS 3

 FROM THE ACADEMY
4JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS

Case Public Health Foodservice Long-Term Care Acute Care Nonacute Care
NCP Situation: Women of Situation: In a Situation: Daughter of Situation: Hospitalized Situation: Female teacher with
reproductive age found with natural disaster, personal care home resident female teacher with complaint of undesired weight
low Hgba and iron-deficient it is estimated concerned with mother’s complaint of undesired gain referred by hospital RDNb
diet that 5 d are food intake. Resident has weight gain. Reason for (Same person as in Acute Care)
needed to repair swallowing difficulties admission: emergency
and restore appendectomy
potable water
supply

Assessment Food Intake: infrequent Availability of Food intake: Food consumption Energy intake: >2,200 kcal/d, Weight Management RDN
consumption of iron-rich potable water: a reported to be <50% of (9,200 kJ/d) Age: 45 y Stated validates assessment data
foods, Mineral element intake : 3-d supply of 1 meals. Reduced intake height: 5 ft 5 in (163 cm), received from hospital RDN
<67% EARc for iron for gender gal (4L)/person/ progresses throughout the Stated weight: 190 lb (86 kg) via a Transition of Care
and age, d as day with fatigue and Body mass index: 32.4, Obese. (C-CDAe) document. (In
Nutritional anemia profile: recommended increased signs/symptoms of Meal snack pattern: Eats practice this means that all
Hgb: high incidence of values by EPAd is dysphagia. when not hungry. Types of data from the acute care
below the population available Weight loss: 7 lb (3.2 kg) in food meals: High-fat foods setting (acute care case in this
reference standard (40% of past month (5% weight loss) frequently, Weight gain: 60 lb Figure) were transmitted as
women of reproductive age) Measured Weight: 148 lb (67 (27 kg) in 24 mo, Readiness to documented to the nonacute
Comparative standards: kg) change nutrition related care setting.
Estimated mineral needs: EAR Nutrition-focused physical behavior: Contemplation,
for iron for women aged findings: Mild/moderate loss expresses concern about
19-50 y¼8.1 mg/d of muscle mass health status
Hgb >120 g/L Diet: Minced and moist Comparative standards: Total
Comparative standards: Total estimated energy needs in
estimated energy needs in 24 h: 1,500 kcal (6,300 kJ),
24 h: 1,500 kcal (6,300 kJ), Method for estimating total
Total estimated protein needs energy needs: Mifflin-St Jeor
in 24 h: 80 g protein/d
Method for estimating total
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energy needs: 22 kcal/kg,

2019 Volume

1.2 g protein/kg
(continued on next page)
Figure 3. Terminology applications in a variety of practice settings. Nutrition Care Process Terminology terms are presented in boldface italic type.
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Number
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Case Public Health Foodservice Long-Term Care Acute Care Nonacute Care
2019 Volume

NCP Situation: Women of Situation: In a Situation: Daughter of Situation: Hospitalized Situation: Female teacher with
reproductive age found with natural disaster, personal care home resident female teacher with complaint of undesired weight
low Hgba and iron-deficient it is estimated concerned with mother’s complaint of undesired gain referred by hospital RDNb
diet that 5 d are food intake. Resident has weight gain. Reason for (Same person as in Acute Care)
-

needed to repair swallowing difficulties admission: emergency

Number

and restore appendectomy

potable water
-

supply

Diagnosis P: Inadequate mineral intake: Iron Limited access to Malnutrition Excessive energy intake Undesirable food choices
(demonstrative related to potable water related to related to related to
example only)f infrequent consumption of related to inadequate oral intake consuming high-fat foods consuming high fat foods
E: iron-rich foods lack of disaster as evidenced by when not hungry when not hungry
S: as evidenced by planning resident consuming <50% of as evidenced by unintended as evidenced by
low dietary iron consumption as evidenced by meals, 5% weight loss, weight gain of 60 lb (27 kg) in unintended weight gain of
(<67% EAR) and low Hgb <5 d supply of 1 evidence of muscle wasting 24 mo and energy intake 60 lb (27 kg) in 24 mo and
(<120 g/dL) in 40% of gal (4 L) /person/ (SGAg B) and reports of exceeding total estimated energy intake exceeding total
women of reproductive age d fatigue and dysphagia energy needs by estimated energy needs by
700 kcal/d (2,900 kJ/d) 700 kcal/d (2,900 kJ/d)
Intervention Mass communication to Team meeting: Nutrition Prescription: 1,500 Nutrition prescription: 1,600 Nutrition prescription: 1,600
JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS

promote Food environment with food kcal 80 g protein/d, purèed kcal/d (6,700 kJ/d), Health kcal/d (6,700 kJ/d), Social
change in Communities, production diet, Meals and snacks: belief model, Motivational learning theory, Goal setting,
neighborhoods and families manager, water Purèed food Level 4 Green, interviewing, Referral to RDN Recommended modifications:
sector. vendors, Moderately thick liquid Level with different expertise. lower-fat snack choices.
Goal: 50% Reduction in materials 3 Yellow Goal: Make appointment with Goal: Altered eating habits
anemia in women of manager to plan Food and Nutrient Delivery: weight management RDN result in weight loss of 5% of
reproductive ageh action points Change diet order to purèed before discharge current body weight

FROM THE ACADEMY

Goal: 5-d Supply with fortified foods and
potable water to between-meals snacks.
provide 1 gal Implement medication
(4 L)/d/person nutrition supplement pass
program.
Collaboration with other
providers: Nursing to monitor
tolerance to purèed diet
(continued on next page)
Figure 3. (continued) Terminology applications in a variety of practice settings. Nutrition Care Process Terminology terms are presented in boldface italic type.
5
 FROM THE ACADEMY
6

Case Public Health Foodservice Long-Term Care Acute Care Nonacute Care
JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS

NCP Situation: Women of
reproductive age found with
low Hgba and iron-deficient
diet
Situation: In a Situation: Daughter of Situation: Hospitalized Situation: Female teacher with
natural disaster, personal care home resident female teacher with complaint of undesired weight
it is estimated concerned with mother’s complaint of undesired gain referred by hospital RDNb
that 5 d are food intake. Resident has weight gain. Reason for (Same person as in Acute Care)
needed to repair swallowing difficulties admission: emergency
and restore appendectomy
potable water
supply

Monitoring and Food Intake, Mineral element Availability of Food intake, Diet Order: Meal Readiness to change nutrition Body mass index, Meal snack
evaluation intake, potable water: observation by nursing related behavior: made pattern, Types of food meals.
Nutritional anemia profile: Water supply of reports tolerance and appointment with weight Eating fruit and whole grain
Hgb: After 3 y, modestly 1 gal (4 L)/ acceptance of diet. management RDN before snacks when hungry, weight
increased consumption of person/d for 5 d Fluid/beverage intake: 95% discharge reduction, confident of ability
iron-rich foods (<EAR) and achieved consumption of commercial Indicator: Adherence to continue
incidence of low Hgb (Hgb Indicator: Water (prepackaged) beverage Criterion: Make appointment Indicator: Body mass index
<120 g/L) not trending supply Weight change: weight gain with weight management Criterion: Body mass index
toward reduction. Program Criterion: at least 3% RDN <31.7
modified 1 gal (4 L)/ Indicator: Percent intake of Indicator: weight reduction
Indicator: Dietary intake of person/d for 5 d served meals snacks, and Criterion: 5% weight
iron beverages reduction of current body
Criterion: >EAR Criterion: at least 95% weight
Indicator: Hgb Indicator: Weight gain
Criterion: Hgb >120 g/L Criterion: weight gain by 3%
a
Hgb¼hemoglobin.
b
RDN¼registered dietitian nutritionist.
c
EAR¼ Estimated Average Requirement.
d
EPA¼Environmental Protection Agency (https://www.epa.gov/sites/production/files/2015-03/documents/planning_for_an_emergency_drinking_water_supply.pdf).
e
C-CDA¼Consolidated Clinical Document Architecture.
f
PES¼Problem, Etiology, Signs, and Symptoms.
--

g
SGA¼Subjective global assessment.
h
http://www.who.int/nutrition/global-target-2025/en/.
2019 Volume

Figure 3. (continued) Terminology applications in a variety of practice settings. Nutrition Care Process Terminology terms are presented in boldface italic type.
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Number
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2003 Ultimate impacts (Part II, Status of Assumptions Stakeholders 2018 Ultimate Impacts
2019 Volume

2008) Ultimate
Impacts

Quality, cost-effective nutrition Ongoing  Nutrition is an essential component of  Health care consumers Safe, effective, efficient, person-
-

care delivered in partnership high quality health care for promotion  Academy members centered, timely, and equitable
Number

with providers, agencies, and of health and prevention of disease  Academy BODc nutrition care delivered in
communities  Data are needed to research the pro-  Academy HODd collaboration with providers,

-

Nutrition care grows nationally
Standardized nutrition
language included in dietitian
education
Ongoing maintenance and
updates of standardized
terminology accomplished by
the Academya and/or partners
Evaluate a national data
warehouse established for a
sustainable, reliable and useful
database for Academy/
dietitians/researchers
National, state, and local
JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS
Ongoing cess and outcomes of nutrition care
 Nutrition and dietetics professionals,
educators, and researchers will use
Realization and enhance a standardized nutrition
language
 Nutrition and dietetics professionals,
educators, and researchers continue to
Ongoing use and improve the NCP
 Nutrition and dietetics professionals
and researchers use standardized ter-
minology in a database to perform
Realization outcomes management and targeted
research
 Nutrition and dietetics professionals
Other health care providers
 Health care payers
 Legislators and regulators
 Health care researchers
 International health care termi-
nology and information man-
agement standards
organizations
 International nutrition and
dietetics professionals and
organizations
agencies, and clients
Nutrition care improves the health and
well-being of all people
Standardized nutrition language
integral to nutrition and dietetics
education
Robust maintenance and updates of
standardized terminology
accomplished by Academy and its
global partners
Popularize a sustainable, reliable,
useful database for Academy and
nutrition and dietetics research and
innovation

policies developed and
supported to foster nutrition
practice, education, and
research
Incorporate NCPb and
International Dietetics and
improve effectiveness through Jurisdictional policies developed and
collaboration supported to foster nutrition
Ongoing  Emphasis on people-centered, value- practice, education, and research
based health care Support adoption of NCP and NCPT
into nutrition and dietetics practice
Realization world-wide
NCPTe is the essential element linking

FROM THE ACADEMY

Nutrition Standardized
Language in to dietetics technological innovations, and
practice worldwide achieving interoperability in
nutrition and dietetics at large
a
Academy¼Academy of Nutrition and Dietetics.
b
NCP¼Nutrition Care Process.
c
BOD¼Board of Directors.
d
HOD¼House of Delegates.
e
NCPT¼Nutrition Care Process Terminology.
Figure 4. Logic Model for standardized terminology. The goal is to provide data to foster nutrition and dietetics practice, education, research, and policy.
7
FROM THE ACADEMY
reported the use of IDNT. Recently, the
nutrition diagnosis terms of NCPT were
mapped to the International Classifi-
cation of Diseases as part of a national
project in Norway.26 Japan and South
Korea also adopted the IDNT.27,28 A
recent global survey of NCP/NCPT
adoption and use has been completed
and the results are being prepared for
publication (personal communication
with Elin Lovestam, June 5, 2018). From
the Academy’s Professional Assessment
Survey, there is increasing trend of use
of Academy resources related to NCP
and NCPT from 2007 to 2017 (NCPRO
Committee face-to-face meeting, June
5, 2017). In this survey, 20% of re-
spondents use NCPT in structured EHRs
(predefined data elements to select
from), 45% in unstructured (free-text)
EHRs, and 30% is a combination of
structured and unstructured docu-
mentation (NCPRO Committee face-to-
face meeting, June 5, 2017). These
data reflect that a large portion of
practitioners are still documenting
electronically in free-text fields. It is
important to acknowledge that
upgrading EHR technology to struc-
tured form is a major and challenging
change that requires resources and
vested stakeholders. Academy survey
data integrated with the awaited in-
ternational survey will assist in devel-
oping global strategies for NCP/NCPT
use and adoption.
Difficulties and challenges of imple-
menting the NCPT have been identified
by several studies. Challenges with
implementation have included
increased time requirement to use
NCPT, concern that other health pro-
fessionals will not read nutrition diag-
nosis statements, limited number of
translations, concern that translation
or dialects may lead to mis-
interpretations of the terminology, and
patient-centered experience data may
not be captured effectively (NCPRO
Committee face-to-face meeting, July
13, 2017).11 Results from a qualitative
study found that Swedish dietitians
expressed ambivalence toward the
terminology in that some terms, espe-
cially in the environmental-behavioral
domain of the Nutrition Diagnosis ter-
minology, were harsh or offensive to-
ward patients.14 These surveys support
that implementation strategies should
include education and training, incor-
poration of terminology into
8 JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS
documentation tools for health records,
and culturally sensitive translation.
Change-management skills and lead-
ership support are also needed for
successful implementation.29,30
Development and Submission
Process
The NCPT communicates the pro-
fession’s unique contribution to health
care. The terminology grew from 62
Nutrition Diagnosis terms in 2006 to
712 NCPT terms in 2008. There are
currently about 1,700 terms (Figure 2)
defining the four steps of the NCP. The
terminology has globally evolved from
principles and initiatives to acknowl-
edge community and public health
nutrition and other specialty practices,
and to achieve inclusion into stan-
dardized EHR terminologies (Figure 5).
Ongoing work to maintain the termi-
nology for an ever-changing profession
is possible because of the valuable
contribution of practitioners and con-
tent experts and the improved process
by which terms are developed.
Throughout the early development
process, the Standardized Language Task
Force sought term suggestions from
practitioners and subject matter experts.
Forms were included within the IDNT
books to encourage term submission
from users of the terminology. Term
submitters provided a term definition,
reference sheet, and supporting evi-
dence. Term refinement was a collabo-
rative process between submitters and
an expert terminology consultant. The
expert terminology consultant also pro-
vided a recommendation for placement
of the term within the terminology
structure. This completed work was
submitted to the committee for inclusion
in the terminology.
The submission process was modified
in 2014 to streamline the involvement of
NCPROC, its supporting workgroups,
and an expert terminology consultant.
The revised process evaluates term re-
quests and modifications from groups of
subject matter experts such as Academy
dietetic practice groups, Academy
leaders, and NCPT users.31
Some important changes to the sub-
mission process include an initial re-
view by the NCPROC to assess the
term’s merit in nutrition and dietetics
practice before allocating consulting
time or obtaining a review by the Clas-
sification Workgroup to determine
whether a proposed or modified term
already exists in an international clinical
terminology standard such as SNOMED-
CT and LOINC. If a term is progressed to
the Classification Workgroup and is
found to already exist in an interna-
tional clinical terminology standard, the
term may be readily adopted without
additional development.
If a proposed term is progressed to
the Classification Workgroup and is not
found in existing international clinical
standards, then development work
may be needed. When expert agree-
ment is reached on the proposed con-
tent, terms are approved by the
NCPROC for inclusion in the next
release of the NCPT.31 Term and defi-
nition development is a consensus
among experts or expert practice
groups that reflects current nutrition
and dietetic practice and research.
Recent examples of this approach
includes terms describing the etiology
and severity of adult and pediatric
malnutrition, International Dysphagia
Diet Standardization Initiative terms,
terms to support the Nutrition-Focused
Physical Examination, and the
Population-Based Nutrition Action
intervention terms (Figure 5).
With the increase in international
NCPT use, NCPROC was restructured to
ensure half the membership was based
internationally. Likewise, the NCPROC
Advisory Workgroup, International
Workgroup, and Classification Work-
group contribute a global talent pool of
subject matter experts. Thus, the NCPT
evolves with new and revised term
requests from a dynamic, international
profession.
Translation
The eNCPT has been translated from US
English into seven languages and di-
alects.10 The translations are available
to all eNCPT subscribers. The Academy
collaborates with international profes-
sional organizations such as associa-
tions and or universities, and their
translating team entities (eg, collabo-
rators, consultants, or other appointed
professionals) in an effort to make the
NCPT a global language with interna-
tional usage.32
Sweden completed its translation in
2011 and has subsequently completed
four updates. Experiences from Swe-
den have shown the importance of
-- 2019 Volume - Number -
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Principles and initiatives Select NCPT examples

2019 Volume

Reflect an International leaders, experts, and reviewers are integral to the NCPT  Complex carbohydrate estimated intake in 24 h (g/day)
international maintenance and Committee processes.  Vitamin A estimated intake in 24 h in mg (micrograms)
perspective US and international standards are included in resources for:  BUNa (mg/dL or mmol/L)
-

 Measures  Creatinine measurement, serum (mg/dL or mmol/L)

Number

 Laboratory units  Estimated daily glycemic load (number) Definition: The esti-
 Nutrient intake mated measure per day reflecting the quantity and type of all
-

NCPb and NCPT are used in several countries. Definitions are developed to
incorporate new NCPT into standardized terminologies and for accurate
conceptual translation.
The NCPROc Committee collaborated with the International Dysphagia Diet
Standardisation Initiative to develop NCPT diet terms and definitions so that
the Academyd could submit them to standardized terminologies.59
Take a people- New term synonyms were deemed necessary for terminology considered
centered approach overly judgmental.35
Recognize the Malnutrition was reclassified as a clinical condition with movement of the
etiology nutrition diagnosis from the Intake domain to the Clinical domain for
JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS
carbohydrate consumed.
 Purèed food Level 4 Green
 Extremely thick liquid Level 4 Green
 Liquidized food Level 3 Yellow
 Moderately thick liquid Level 3 Yellow
 Food and nutrition-related knowledge deficit synonym
Limited food and nutrition-related knowledge
 Undesirable food choices synonym Unbalanced diet
 Physical inactivity synonym Limited physical activity
 Moderate chronic disease or condition related malnutrition
 Severe acute disease or injury related malnutrition

and severity of more accurate modeling of these conditions.  Mild nonillness-related pediatric malnutrition
malnutrition  Moderate illness-related pediatric malnutrition
(undernutrition) Malnutrition indicators from the Academy consensus papers for adults and  Temporalis muscle atrophy
pediatrics have been included in the NCPT reference material.60,61  Handgrip strength
 Head circumference for age z score
 Weight for length z score

FROM THE ACADEMY

Characterize nutrition Nutrition interventions at the institutional, community, and policy Population-based nutrition action
interventions in levels describe actions to address nutrition problems influenced by the  Social ecological model
populations environment in which people live, work, and play.  Social marketing
Fully integrating the Social Ecological Model, a new Nutrition interventions  Mass communications
domain, aligned the NCPT with the Centers for Disease Control and  Food environment change
Prevention Health Impact Pyramid and the World Health Organization  Public policy change
Population Health Promotion Model, which was adopted in the Ottawa  Food production and provision settings
Charter on Health Promotion.62-64  Government settings
 Agriculture sector
 Communities, neighborhoods, families sector
(continued on next page)
Figure 5. Major principles and initiatives of Nutrition Care Process Terminology (NCPT).
9
 FROM THE ACADEMY
10
JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS

Principles and initiatives Select NCPT examples

Represent content for Practitioner-led efforts to reflect their practice and research with neonatal,  Breastmilk feeding attempts in 24 h
specialized practice long-term care, inborn errors of metabolism, gastrointestinal disorder,  Docosahexaenoic acid estimated intake in 24 h
and community nutrition and public health populations are included in  Total fat from intravenous fluids
NCPT adding 781 assessment/monitoring and evaluation terms, 107  Total protein per kilogram estimated in 24 h
diagnosis, and 326 intervention terms since all 4 steps were published in  Phenylalanine, dried blood spot
IDNTe in 2008.5  Pressure injury of hip
 Excessive growth rate
 Consistent carbohydrate diet
 Modify composition of parenteral nutrition
 Modify route of parenteral nutrition
Clarify usage of The NCPRO Committee has responded to practitioner concerns and  Altered gastrointestinal function
terminology questions by:  Impaired nutrient utilization
Providing guidance for diagnoses associated with exocrine and  Intake of types of proteins inconsistent with needs
endocrine functions,  Predicted inadequate energy intake
Relocating an indicator for gluten from a carbohydrate to a protein  Predicted breastfeeding difficulty
diagnosis because of the protein in gluten responsible for the intolerance  Predicted food medication interaction
or allergy, and
Defining predicted nutrition diagnoses that are anticipated based on
observation, experience, or scientific reason.
Structure unique Removing the need for hierarchical terminology construction by creating  Potassium estimated intake in 24 h
nutrition data complete terms and submitting them to standardized terminologies (ie,  Serum potassium measurement
SNOMED CTf and LOINCg), each term is assigned a 5-digit Academy  Inadequate potassium intake
unique identifier.20,21 This facilitates data tracking in electronic record  Potassium modified diet
systems. While all terms in nutrition diagnosis and intervention have  Potassium supplement therapy
external mappings, work continues in assessment.  Estimated potassium needs
Ambiguous terms, such as suboptimal and less than optimal, have been  Growth rate below expected
replaced with more accurate labels.  Intake of types of fats inconsistent with needs (specify)

--

Terms that conveyed more than 1 idea have been separated for Limited access to food
independent expression.  Limited access to potable water
2019 Volume

 Measured weight
 Stated weight
 Loss of subcutaneous fat overlying the ribs
-

(continued on next page)

Number

Figure 5. (continued) Major principles and initiatives of Nutrition Care Process Terminology (NCPT).
-
 FROM THE ACADEMY

creating a work group of experienced

Referral to registered dietitian nutritionist with different

dietitians as well as having an ongoing
dialogue and consensus building
among the key contacts (expert di-
etitians with varied practice experi-
ences and other health care
professionals) involved in the trans-
lation.33 To be useful to nutrition and

Referral to community agencies/programs

dietetics practitioners, a conceptual
translation that is accurate, unambig-
Inadequate pantothenic acid intake

Total fiber estimated intake in 24 h

uous, linguistically correct, and consis-

Collaboration with other providers
Iliac crest abnormal prominence

tent is needed. Translating challenges

Fruit servings estimated in 24 h

include differences in culture, health

Inadequate selenium intake

care systems, legal issues, differences

in the use of nutrition and dietetics
terms, and references to US-specific
concepts in the terminology. Concep-
Select NCPT examples

tual translation is facilitated by clear

definitions and supporting reference
sheets.
expertise

The Academy welcomes translations of

the eNCPT. To obtain acceptance from
the Academy to translate, translators
need support from their national di-










etetics association or equivalent profes-

sional governing entities or university.
fruit servings, psyllium) not previously in standardized terminologies are

Some terms label procedures were revised to clarify them as nutrition and
Nutrition concepts (eg, loss of subcutaneous fat overlying the ribs, iliac crest
abnormal prominence), and substances (eg, pantothenic acid, selenium,

Figure 5. (continued) Major principles and initiatives of Nutrition Care Process Terminology (NCPT).

The responsibility for the quality of the

translation and associated costs lie with
the translating organization. A concern
for the future is that the costs to com-
plete an initial translation, subsequent
maintenance, and access to the eNCPT
may not be affordable for dietetics asso-
ciations or other interested organizations
SNOMED CT¼Systematized Nomenclature of Medicine Clinical Terminology.

in developing economies. There is a need

for a sustainability model that facilitates
and/or funds translations in less-affluent
countries.

SYNONYMS: THE GLOBAL MOVE

TOWARD PEOPLE-CENTERED
LOINC¼Logical Observation Identifiers Names and Codes.
now present for worldwide use.

IDNT¼International Dietetics and Nutrition Terminology.

CARE
dietetic practitioner actions.

NCPRO¼Nutrition Care Process Research Outcomes.

The adoption of a people-centered

care approach, sometimes more
Academy¼Academy of Nutrition and Dietetics.

narrowly referred to as patient-

centered or person-centered care, is
growing globally.34 This approach
includes providing an individual full
access to his or her health care in-
formation. The Organization for Eco-
nomic Co-operation and
NCP¼Nutrition Care Process.
BUN¼Blood Urea Nitrogen.

Development has developed quality

Principles and initiatives

health care indicators, including in-

dicators to track patient-centered
care, that allow comparisons across
member countries.35,36 The inclusion
of patient-centered health care mea-
sures into health care system perfor-
mance assessments has occurred in
many countries, including Australia,
Canada, Denmark, France, Germany,
b

g
e
a

Switzerland, the Netherlands, New

-- 2019 Volume - Number - JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS 11

FROM THE ACADEMY
Zealand, United Kingdom, and the
United States.34
Leadership and cultural trans-
formation are part of the patient-
centered care journey.37 In countries
where clients have full access to their
health record, it is very important to
use terminology that is not perceived
to be harsh or offensive. There is
greater recognition for the need of
people to be considered as individuals
with varied needs and not as clinical
symptoms. The choice of words used
during an episode of care ought to
reflect this philosophy. A psychologist’s
view regarding successful use of stan-
dardized language is that it should
correspond to situations in practice,
have internal coherence, and intuitive
appeal to users.38
The provision of care and the language
describing that care needs to be
respectful and responsive to individual
preferences and values. With the global
adoption and implementation of NCPT,
the terminology needs to communicate
the care provided to culturally and
linguistically diverse populations. Feed-
back from international surveys has
indicated the desire for terms that are
more patient-centered. The 2014
Australian NCPT Implementation Survey
showed improvement in NCPT attitudes,
knowledge, and use over time.39 In that
longitudinal survey, free-text comments
were collected to understand the chal-
lenges or barriers related to NCPT use, in
particular areas of practice. The dietitian
respondents’ comments included gen-
eral sentiments such as, “I would cringe
to write.,” “Some of the terminology is
quite derogatory of the client/patient,”
“An impersonal way of describing an
interaction” and, “Culturally words have
slightly different meanings. I change
some words when I deem the language
judgmental.”
Synonym submissions from New
Zealand have provided alternatives to
the words deficit and inability. Specif-
ically, “Self-monitoring deficit,” “Food-
and nutrition-related knowledge
deficit” and, “Inability to manage self-
care” are examples of terms that could
make an individual feel pessimistic,
discouraged, or embarrassed. An in-
dividual’s personal strengths and
capability may be overshadowed by a
perceived critical expression. The syn-
onym limited for inability is less judg-
mental, more empathetic, and is
constructive with a positive regard for
12 JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS
Behavioral and Environmental Domain
Knowledge and Beliefs
NCP Term
Food and nutrition-related knowledge
deficit
Self-monitoring deficit
Undesirable food choices
Physical inactivity
Inability to manage selfcare
Impaired ability to prepare food/meals
Figure 6. Nutrition Care Process (NCP) Terminology-approved synonyms can be used
interchangeably in place of the original term without altering the meaning of the
term. NCP¼Nutrition Care Process.
the individual. Utilizing the term sub-
mission process, a number of syno-
nyms for diagnostic terms within the
Behavioral-Environmental Domain
were approved and included in the
2016 eNCPT release (Figure 6). Syno-
nyms can be used interchangeably in
place of the original term without
altering the meaning.
NCPT INCLUSION IN CLINICAL
TERMINOLOGY AND
ELECTRONIC HEALTH
INFORMATION MANAGEMENT
STANDARDS
The Academy has been submitting NCPT
terms to SNOMED-CT and LOINC since
2011, and has developed electronic
health information management stan-
dards for Health Level 7 (HL7).20,21,40
SNOMED-CT and LOINC are clinical ter-
minology standards required for use in
US EHRs and similarly used in many
other countries. Both standards are used
internationally in EHRs. Generally
speaking, SNOMED-CT terms encompass
terms from all NCP steps. LOINC includes
primarily quantitative Nutrition Assess-
ment and Nutrition Monitoring and
Evaluation terms.
In the United States, terminology
standards also facilitate coding the
financial value of care for procedures
and services using Current Procedure
Terminology of the American Medical
Association41 and Healthcare Com-
mon Procedure Coding Systems G-
codes.42 These codes are maintained
jointly by the alpha-numeric editorial
panel with participation from the
Centers for Medicare and Medicaid
Services and other payer coding
schemes.43 As part of SNOMED-CT and
Synonym
Limited food and nutrition-related
knowledge
Limited self-monitoring
Unbalanced diet
Limited physical activity
Limited ability to manage self-care
Limited ability to prepare food/meals
LOINC, NCPT provides terms useful in
the United States for coding social
determinants of health from nonphy-
sician clinical documentation using
the International Classification of
Diseases.44,45
The submission of NCPT to clinical
terminology standards started with
nutrition assessment terms to meet an
urgent regulatory standard for EHRs in
the United States.46 A consequence of
this process was that submissions of
NCPT to the International Health
Technology Standards Development
Organization, now SNOMED Interna-
tional, were for the most part available
in the US edition of SNOMED-CT and
not other countries. SNOMED-CT has
multiple country editions in addition to
an overarching International Edition.20
LOINC has a single edition with
translations.21
The widespread transition to EHRs
has made it apparent that there is a
need to have NCPT incorporated into
the SNOMED-CT International Edition.
This would make NCPT available to all
entities using SNOMED-CT. Recently,
dietetics associations from Australia,
Brazil, Canada, Denmark, Israel,
Mexico, New Zealand, Norway,
Switzerland, Sweden, and the United
States requested inclusion of NCPT
terms into the International Edition of
SNOMED-CT. This request was
accepted and in July 2018 all NCPT
terms that were in the US edition are
now available in the SNOMED-CT In-
ternational Edition.20 This is a major
step forward for continued interna-
tional NCPT availability and adoption.
The Academy maps and models the
NCPT to SNOMED-CT and LOINC on an
ongoing basis. Mapping and modeling
-- 2019 Volume - Number -
 FROM THE ACADEMY

is a process to confirm that an equiv-
alent relationship with a term exists
in a terminology standard and ensures
that NCPT communicates the same
meaningful information and signifi-
cant facts in SNOMED-CT or LOINC.
The resulting database and available
nutrition standards are used by de-
velopers to match accurately NCPT to
SNOMED-CT or LOINC terms when
designing an EHR.47 This may not
appear as a point of interest to nutri-
tion and dietetics professionals at
first. However, in EHRs the NCPT is
what the user sees and uses upfront
when they document and in the back
end are the SNOMED terms. EHRs
store SNOMED data for later reporting
and research. Thus, this matching be-
tween NCPT and SNOMED is a neces-
sary foundation to be able to conduct
large-scale quality improvement such
as reporting on electronic quality mea-
sures, and/or NCP-related research. Pro-
fessionals are encouraged to advocate for
NCPT matching to SNOMED at their
workplace EHR and work proactively
with information technology staff to
make this happen.
Inclusion of NCPT in the clinical ter-
minology standards facilitates repre-
sentation of NCPT in electronic health
information management standards
such as those of HL7.40 This represen-
tation is fundamental to the
interoperability of electronic health
data and records. Interoperability aims
to provide a seamless, secure flow of
meaningful electronic information to
improve care (Figure 7).
To foster nutrition care across care set-
tings in the United States, the Academy
provides routine input on nutrition
informatics developments and related
needs to the federal Office of the National
Coordinator of Health Information Tech-
nology. This input is aimed to update the
Interoperability Standards Advisory.47,48
A recent major development is the revi-
sion of the Electronic Nutrition Care Pro-
cess Record System (ENCPRS) for
international use. The ENCPRS is a func-
tional electronic health data management
standard available from HL7 that defines
the necessary content and messaging for
nutrition and dietetics-related documen-
tation. ENCPRS relies on NCP and NCPT for
content. Also, in the United States, work is
underway to develop an HL7 standard for
transition of care documentation that in-
cludes templates for describing nutrition
care plans using NCP and NCPT. Termi-
nology standards and data management
are essential structures to ensure inter-
operability among EHRs (Figure 7).
NCPT IN RESEARCH
The NCPT as a structured terminology
has begun to demonstrate its utility in
providing data for research (Figure 4).
As described in the NCP model update,2
a data aggregation platform, the Acad-
emy of Nutrition and Dietetics Health
Informatics Infrastructure (ANDHII),
the architecture of which contains the
NCPT, was used in studies to “explore
the feasibility of validating malnutri-
tion diagnostic criteria”22 and “inves-
tigate the influence of evidence-based
nutrition practice guidelines for the
prevention of diabetes on both practice
patterns and patient outcomes.”18
ANDHII is forging new frontiers glob-
ally. ANDHII is being increasingly used
in nutrition research, education, and
clinical and public health settings in
the United States and around the
world. This web-based NCPT tool can
be especially helpful in settings where
the EHR is not structured yet to capture
nutrition care and/or in public health
settings where a nutrition-focused
evaluation framework is needed. Edu-
cators use ANDHII to teach future cli-
nicians in classrooms, internship
settings, and/or student-led clinics.
ANDHII-focused activities empower
students to enhance their informatics
skills, apply their NCPT in practice
conditions, and monitor the efficacy of
their work. Other data aggregation
tools that contain NCPT content can
also be employed in research or quality
improvement projects. Leveraging the

NCP and NCPT Data aggregation

Terminology/electronic health information management standards (e.g.Health Information
(SNOMED CT, LOINC/HL7) Exchange [HIE], Academy
of Nutrition and Dietetics
Health Informatics
Infrastructure [ANDHII])
Hospitalized obese female complains of unwanted weight gain, Coded value
referred to outpatient RDN with weight management expertise Quality improvement
Practiced based
research

Transition of care document

Improve
NCP and NCPT
care
Terminology/electronic health information management standards
(SNOMED-CT, LOINC/HL7)

Data aggregation
(HIE, ANDHII)
Obese female referred from hospitalization desires weight Coded value, QI
management care Practiced based
research
Figure 7. Interoperability schema. NCP¼Nutrition Care Process. NCPT¼Nutrition Care Process Terminology. SNOMED CT¼
Systematized Nomenclature of Medicine Clinical Terminology. LOINC¼Logical Observation Identifiers Names and Codes.
HL7¼Health Level 7 International. RDN¼registered dietitian nutritionist.

-- 2019 Volume - Number - JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS 13

FROM THE ACADEMY
data derived from NCPT is an avenue to
demonstrate effectiveness of nutrition
and dietetics care.
GOING FORWARD
The adoption and consistent use of the
NCPT promotes and strengthens nutri-
tion communications among health
professionals, their clients, and other
customers. Several of the 2008 aspira-
tions and goals for the NCPT have been
realized (Figure 4). These include the
incorporation of NCPT into EHRs and
standardized clinical terminologies to
communicate nutrition care. Also,
expansion and revisions have occurred
due to changes in the field of nutrition
and dietetics. The role of NCP and NCPT
in informatics is now better appreci-
ated as NCPT becomes a part of clinical
terminology and electronic health in-
formation management standards. The
high interest in international trans-
lation, adoption, and enhancement of
NCPT continues to grow. Further
development of the NCPT in the areas
of diagnosis etiology, nutrition assess-
ment and monitoring, and evaluation
status is needed. Standardization of
etiologies will help reveal which types
of interventions effectively resolve
specific etiologies, a key part of diag-
nosing. This is important because the
same nutrition problem can have a
different etiology. Also, standardized
labels for status have not been estab-
lished, but these are needed because
care providers and institutions use
different ways to document status.
Research efforts to validate the ter-
minology are needed. Validation im-
proves the quality of the terminology
and ensures that the terminology is
used appropriately.49 The NCPM in-
cludes guidance “to research the NCP.”2
Some work has been done toward
validation of NCP terms in the United
States. One study has tested the con-
tent validity of diagnostic terms using a
convenience sample of registered di-
etitians (RDs).50 Another study
measured the reliability of nutrition
diagnosis terms among RDs.51 Finally,
investigations have focused on the
validation of nutrition diagnoses used
by RDs specializing in cancer,52 pedi-
atrics,53 and gerontology.54 These in-
vestigations were in agreement that
some refinement of the evaluated
nutrition diagnoses may be warranted.
An additional consideration for
14 JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS
research is NCPT acceptance by clients
and other health care providers.
The need for structured diagnosis
etiologies in the NCPT is being
explored. Recent research demon-
strates that there is little agreement in
etiology selection among professionals
when assessing nutrition-related data
from the same client.55 A specific
nutrition diagnosis term may be
related to a variety of etiologies. It is
the etiology that primarily determines
the intervention to resolve or mitigate
nutrition diagnoses.2 Being able to link
nutrition diagnosis etiologies or etiol-
ogy categories and efficacious in-
terventions would be useful in practice.
Descriptors that define the status of
diagnosis resolution are being
developed.
The documentation of the interven-
tion step needs to be further refined.
The intervention consists of the plan
and the implementation. The plan
(which includes the nutrition pre-
scription and goals) and the imple-
mentation of the plan could be further
defined, structured, and quantified to
assist professionals in designing
measurable and comparable in-
terventions. Also, defined scales to
monitor effectiveness of an interven-
tion is being considered for inclusion in
the NCPT. Such progress in the termi-
nology will facilitate outcomes
research in a substantive way.
The need for ongoing professional
education and training is important to
highlight. Earlier cited surveys on the
usage and adoption of the NCPT indi-
cate that even countries with long-
standing implementation, such as the
United States, can improve the utiliza-
tion of NCPT. Hence, education efforts
in the future will not only target stu-
dents, but also practicing and returning
practitioners. Collaborative profes-
sional networks, also known as Com-
munities of Practice and continuously
updated experiential training delivered
by NCP/NCPT certified trainers can be
important methods to effectively reach
and support a broad number of pro-
fessionals. Through interactive educa-
tional methods, where learning takes
place through connections formed
among colleagues, learners can expand
their connections and these connec-
tions drive new learning and decision
making.56 Interprofessional education
that incorporates nutrition and di-
etetics also warrants consideration.57
CONCLUSIONS
Over the past decade, the Academy has
successfully pioneered a standardized
terminology to communicate the NCP
performed by nutrition and dietetics
practitioners. NCPT has been adopted,
implemented, and enhanced by inter-
national professionals and organizations.
NCPT has been embraced by terminol-
ogy and health information manage-
ment standards. The terminology has
grown to include specialty practices and
varied practice settings as well as
culturally sensitive synonyms. NCPT
growth is supported by a responsive
process to accommodate new terms that
address inevitable practice changes.
Research tools have been created to
explore NCPT implementation, its utility
in describing the value of nutrition and
dietetics practice, and the effectiveness
in communicating quality practice that
improves the health of communities. The
need for training and continuing educa-
tion regarding NCP and NCPT is ongoing.
NCPT has become internationally essen-
tial to the field of nutrition and dietetics,
intersecting technology, practice, and
research for innovation and discovery.
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AUTHOR INFORMATION
W. I. Swan is a past chair of the Nutrition Care Process Research Outcomes Committee, a member of the Classification Workgroup of the Academy
of Nutrition and Dietetics, and a retired dietitian based in Ranchos de Taos, NM. D. G. Pertel is an expert terminology consultant for the Nutrition
Care Process Terminology, and principal, Pertel Nutrition Consulting, Brookline, MA. B. Hotson is a member, Nutrition Care Process Research
Outcomes International Workgroup of the Academy of Nutrition and Dietetics, and a regional clinical manager, acute care, nutrition and food
services, Winnipeg Regional Health Authority, Winnipeg, Manitoba, Canada; at the time of the study, she was a member, Nutrition Care Process
Research Outcomes Committee. L. Lloyd is chair, Nutrition Care Process Research Outcomes Committee, a member, Nutrition Care Process
Research Outcomes International Workgroup of the Academy of Nutrition and Dietetics, and a senior renal dietitian, Department of Nutrition and
Dietetics, Auckland City Hospital, Auckland, New Zealand. Y. Orrevall is a member, Nutrition Care Process Outcomes International Workgroup of
the Academy of Nutrition and Dietetics; head of research and development, Education and Innovation, Function Area Clinical Nutrition, Kar-
olinska University Hospital, Stockholm, Sweden; and an associated researcher, Department of Learning, Informatics, Management, and Ethics,
Karolinska Institute, Stockholm, Sweden. N. Trostler is a member, Nutrition Care Process Research Outcomes International Workgroup of the
Academy of Nutrition and Dietetics, and a professor emeritus, Faculty of Agriculture, Food, and Environmental Sciences, Hebrew University of
Jerusalem, Rehovot, Israel; at the time of the study, she was a member, Nutrition Care Process Research Outcomes Committee of the Academy of
Nutrition and Dietetics. A. Vivanti is chair, Nutrition Care Process Research Outcomes International Workgroup of the Academy of Nutrition and
Dietetics; vice chair, Nutrition Care Research Outcomes Committee; and a research and development dietitian, Department of Nutrition and
Dietetics, Princess Alexandra Hospital Brisbane, Brisbane, Queensland, Australia; and senior lecturer, School of Human Movement and Nutrition
Studies, University of Queensland, Brisbane, Queensland, Australia. K. B. Howarter is principal, Ms. Nutrient Food and Nutrition Consulting
Services, Evanston, IL; at the time of the study, she was director, Nutrition Care Process, Research International Scientific Affairs, Academy of
Nutrition and Dietetics, Chicago, IL. C. Papoutsakis is a senior director, Data Science Center, Research International Scientific Affairs, Academy of
Nutrition and Dietetics, Chicago, IL.
Address correspondence to: Constantina Papoutsakis, PhD, RD, Academy of Nutrition and Dietetics, 120 S Riverside Plaza, Suite 2190, Chicago, IL
60606. E-mail: cpapoutsakis@eatright.org
STATEMENT OF POTENTIAL CONFLICT OF INTEREST
C. Papoutsakis is an employee and D. G. Pertel is a consultant, Academy of Nutrition and Dietetics, Chicago, IL, which has a financial interest in
the Nutrition Care Process Terminology.
FUNDING SUPPORT
The Academy of Nutrition and Dietetics is the source of funding for the present update on the Nutrition Care Process Terminology. The authors
and experts who conducted the update on the Nutrition Care Process Terminology had complete autonomy during all stages of the update and
writing of the present manuscript.
AUTHOR CONTRIBUTIONS
All authors made substantial contributions to the conception of the work, co-drafted the initial draft, and revised it critically for important in-
tellectual content. W. I. Swan and C. Papoutsakis edited the manuscript post review.

16 JOURNAL OF THE ACADEMY OF NUTRITION AND DIETETICS -- 2019 Volume - Number -